LEGAL & GENERAL CRITICAL ILLNESS COVER CONDITIONS HISTORY REFERENCE.

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1 REFERENCE. This document provides you with a history of Critical Illness Cover conditions and how they ve changed over time. So you have all the information you need to hand. ENTER

2 2 WELCOME. To navigate through the history use the summary table. You can either click on a tick to go directly to the definition of a condition on a particular date, or click on the date to see the full list of conditions changed/covered in that particular month/year. Changes to the conditions covered have been grouped by the date changes were made. Where definition names have changed, the most recent definition name appears in brackets below it.

3 3 KEY: Definition available 3 Definition change 3 Not available Illness 04/02/96 03/06/96 28/07/97 26/06/99 20/10/02 18/01/04 25/07/04 18/03/07 23/05/10 09/01/11 27/11/11 05/08/12 14/04/13 21/09/14 06/12/15 Alzheimer s Disease Angioplasty Aorta Graft Surgery Aplastic Anaemia Bacterial Meningitis Benign Brain Tumour Blindness Cancer Carcinoma in Situ of the breast Cardiac arrest Cardiomyopathy Coma Coronary Artery By-Pass Grafts Creutzfeldt-Jakob Disease (CJD) Deafness Dementia Encephalitis Heart Attack Heart Valve Replacement or Repair HIV infection Kidney failure Liver failure Loss of hands or feet Loss of speech Low grade Prostate Cancer Major Organ Transplant Motor Neurone Disease

4 4 KEY: Definition available 3 Definition change 3 Not available Illness 04/02/96 03/06/96 28/07/97 26/06/99 20/10/02 18/01/04 25/07/04 18/03/07 23/05/10 09/01/11 27/11/11 05/08/12 14/04/13 21/09/14 06/12/15 Multiple Sclerosis Multiple System Atrophy Open Heart Surgery Paralysis of limbs Parkinson s Disease Primary Pulmonary Hypertension Progressive Supranuclear Palsy Removal of an Eyeball Respiratory failure Spinal Stroke 3 Stroke Systemic Lupus Erythematosus Terminal Illness Third Degree Burns Total and Permanent Disability Traumatic brain injury Total no of conditions * 30* *HIV infection had 3 separate definitions from 18/01/2004 until 17/03/2007.

5 5 4 FEBRUARY 1996 Summary CIC introduced as a rider available on Level Term Assurance, Convertible Term Assurance and Decreasing Term Assurance plans. ANGIOPLASTY AORTA SURGERY (AORTA GRAFT SURGERY) BENIGN BRAIN TUMOUR BLINDNESS BURNS (THIRD DEGREE BURNS) CANCER The undergoing of balloon angioplasty to correct the narrowing or blockage of two or more arteries, when the Life Assured has limiting anginal symptoms. Any claim must be supported by: evidence of prior treatment (on appropriate medication) from an appropriate registered medical practitioner holding an appointment at a hospital in the UK or Republic of Ireland; and evidence of significant electrocardiogram changes; and evidence of angiography showing 70% obstruction of two or more coronary arteries. The actual undergoing of surgery for a disease of the aorta needing excision and surgical replacement of aportion of the diseased aorta with a graft. For the purposes of this definition aorta shall mean the thoracic and abdominal aorta but not its branches. This means a non malignant tumour within the cranium, and does not include cysts, granulomas, malformations in, or of, the arteries or veins of the brain, haematomas or tumours in the pituitary gland or spine. Total and irreversible loss of sight in both eyes. Total is defined as a corrected visual acuity of 3/60 or less in each eye. This means third degree burns covering at least 20% of the surface area of the body of the Life Assured, as certified by a specialist consultant. A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes leukaemia and Hodgkin s disease but excludes: 1. non-invasive cancer in situ, 2. tumours in the presence of HIV, 3. any skin cancer other than invasive malignant melanoma.

6 6 4 FEBRUARY 1996 COMA CORONARY ARTERY DISEASE SURGERY (CORONARY ARTERY BY-PASS GRAFTS) This means unconsciousness, with no reaction to stimuli continuing for at least 96 hours. Life support systems must be required throughout the period of unconsciousness. The undergoing of open heart surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding balloon angioplasty (except as defined in Angioplasty) laser or any other procedures. HEART ATTACK HEART VALVE SURGERY (HEART VALVE REPLACEMENT OR REPAIR) HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) The death of a portion of the heart muscle as a result of inadequate blood supply as evidenced by an episode of typical chest pain, new electrocardiographic change and by the elevation of cardiac enzymes. The undergoing of open-heart surgery to correct valvular abnormalities. The Life Assured being infected by Human Immuno-deficiency Virus (HIV), or, suffering from Acquired Immune Deficiency Syndrome only if the Life Assured s occupation is in the list below and providing that all of the following are satisfied: (i) The infection arose in the course of the Life Assured s normal duties and has been acquired as a result of contact with an HIV infected person involving passing of blood or body fluid from an HIV infected person or with an HIV infected medical instrument. (ii) The incident that results in such contact must have occurred after the Policy Date and must have been reported, investigated and documented in accordance with established procedures for such an accident. (iii) The Life Assured must have been tested within five days of the incident and shown not to have antibodies of HIV. (iv) Within 10 days of the incident, the circumstances were reported in full to Legal & General Assurance Society Ltd at its Principal Office and, it was reported that the Life Assured underwent the blood test, referred to in (iii) above. (v) A further blood test within 12 months of the incident indicated the presence of HIV or antibodies to such a virus.

7 7 4 FEBRUARY 1996 HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) Continued KIDNEY FAILURE LOSS OF HEARING (DEAFNESS) The list of occupations referred to above comprises: Hospital Doctors, Surgeons and Consultants Hospital Nurses Hospital Porters Hospital Caterers Hospital Cleaners General Practitioners and nurses employed by them Dental Surgeons Dental Nurses District Nurses Midwives Paramedics Ambulance Workers Hospital Laundry Workers Fire Brigade Fire-fighters Policemen and Policewomen Laboratory technicians in a medical facility Prison Staff End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated. Total and irreversible loss of hearing in both ears which must be established for a continuous period of 12 months, as confirmed by an appropriate consultant physician holding an appointment in a hospital in the UK or Republic of Ireland. LOSS OF SPEECH Total and irreversible loss of the ability to speak because of physical injury or disease, which must be established for a continuous period of 12 months, as confirmed by an appropriate consultant physician holding an appointment in a hospital in the UK or Republic of Ireland.

8 8 4 FEBRUARY 1996 LOSS OF TWO OR MORE LIMBS (LOSS OF HAND OR FOOT) MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) PARKINSON S DISEASE PRE SENILE DEMENTIA BEFORE AGE 65 (DEMENTIA) The total and irrecoverable loss of two or more limbs. A limb is defined as an arm above the wrist joint or a leg above the ankle joint. The actual undergoing as a recipient of, or confirmation of acceptance on to the official United Kingdom programme waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow. Motor neurone disease as diagnosed by a consultant neurologist holding an appointment in a hospital in the UK or Republic of Ireland. Confirmation by a consultant neurologist of definite diagnosis of multiple sclerosis producing at least moderate neurological abnormalities which have persisted for a continuous period of six months. The total and irrecoverable loss of the use of two or more limbs. An unequivocal diagnosis of Parkinson s disease made by a consultant neurologist holding an appointment in a hospital in the UK or Republic of Ireland. Only idiopathic Parkinson s disease is covered. All other forms of Parkinsonism are excluded. A diagnosis, before the 65th birthday of the Life Assured, by a consultant neurologist holding an appointment in a hospital in the UK or Republic of Ireland of pre senile dementia such as that caused by Alzheimer s disease. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas. STROKE A cerebrovascular incident resulting in permanent neurological damage. Transient ischaemic attacks are specifically excluded.

9 9 3 JUNE 1996 Summary CIC introduced as a standalone product and Permanent and Total Disability added. ANGIOPLASTY AORTA SURGERY BENIGN BRAIN TUMOUR BLINDNESS BURNS (THIRD DEGREE BURNS) CANCER COMA CORONARY ARTERY DISEASE SURGERY (CORONARY ARTERY BY-PASS GRAFTS) HEART ATTACK HEART VALVE SURGERY (HEART VALVE REPLACEMENT OR REPAIR) HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION)

10 10 3 JUNE 1996 KIDNEY FAILURE LOSS OF HEARING (DEAFNESS) LOSS OF TWO OR MORE LIMBS (LOSS OF HAND OR FOOT) LOSS OF SPEECH MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) PARKINSON S DISEASE

11 11 3 JUNE 1996 PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) PRE SENILE DEMENTIA BEFORE AGE 65 (DEMENTIA) The Sum Assured will be payable: (a) If the Life Assured is not in any gainful occupation immediately before the onset of disability and suffers, through illness or accident, a mental or physical irreversible disability which, in the opinion of the Chief Medical Officer of Legal & General, results in the Life Assured being permanently unable to perform, without the direct assistance of a third party, four or more of the following functions: (i) Mobility the ability to move from one room to another adjoining room or from one side of a room to another to get in and out of bed or a chair without requiring physical assistance of another person. (ii) Continence the ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene. (iii) Dressing or undressing self putting on or taking off all necessary items of clothing without requiring assistance of another person. (iv) Washing and bathing self washing or bathing to the extent needed to maintain personal cleanliness without requiring assistance of another person. (v) Eating all tasks of getting food into the body once it has been prepared. (vi) Toileting getting to and from the toilet, transferring on or off the toilet and associated personal hygiene. OR (b) One of the Any Occupation definition or Own Occupation definition wordings: Any Occupation definition If the Life Assured, by reason of sickness or accident, is totally unable to follow any occupation and in the opinion of the Chief Medical Officer of Legal & General is likely to remain so permanently. Such decision will be based on all of the medical evidence available. Own Occupation definition If the Life Assured, by reason of sickness or accident, is totally unable to follow his or her occupation and in the opinion of the Chief Medical Officer of Legal & General is likely to remain so permanently. Such decision will be based on all of the medical evidence available. STROKE

12 12 28 JULY 1997 Summary Changes to Cancer definition. Permanent and Total Disability definition added to term + CIC. ANGIOPLASTY AORTA GRAFT SURGERY BENIGN BRAIN TUMOUR BLINDNESS BURNS (THIRD DEGREE BURNS) CANCER A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia but the following cancers are excluded: 1. Non-invasive cancer in situ, 2. All forms of lymphoma in the presence of any Human Immunodeficiency virus, 3. Kaposi s sarcoma in the presence of any Human Immunodeficiency virus, 4. Any skin cancer other than invasive malignant melanoma COMA CORONARY ARTERY DISEASE SURGERY (CORONARY ARTERY BY-PASS SURGERY) HEART ATTACK

13 13 28 JULY 1997 HEART VALVE SURGERY (HEART VALVE REPLACEMENT OR REPAIR) HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) KIDNEY FAILURE LOSS OF HEARING (DEAFNESS) LOSS OF TWO OR MORE LIMBS (LOSS OF HAND OR FOOT) LOSS OF SPEECH MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS) PARKINSON S DISEASE

14 14 28 JULY 1997 PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) PRE SENILE DEMENTIA BEFORE AGE 65 (DEMENTIA) STROKE

15 15 26 JUNE 1999 Summary Changes to most definitions and Alzheimer s Disease added. ALZHEIMER S DISEASE BEFORE AGE 65 (ALZHEIMER S DISEASE) ANGIOPLASTY AORTA GRAFT SURGERY BENIGN BRAIN TUMOUR A diagnosis, before the 65th birthday of the Life Assured by a consultant neurologist of Alzheimer s disease. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas. The undergoing of balloon angioplasty to correct the narrowing or blockage of two or more arteries, when the Life Assured has limiting anginal symptoms. Any claim must be supported by: Evidence of prior treatment (on appropriate medication) from an appropriate registered medical practitioner holding such an appointment at a hospital in the UK and; Evidence of significant electrocardiogram changes and; Evidence of angiography showing 70% obstruction of two or more coronary arteries. Undergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches. A non malignant tumour in the brain resulting in permanent deficit to the neurological system. Tumours or lesions in the pituitary gland are not covered. BLINDNESS CANCER (MOST MALIGNANT TYPES) (CANCER) Total, permanent and irreversible loss of all sight in both eyes. A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin s disease but the following are excluded: All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ, All forms of lymphoma in the presence of any Human Immunodeficiency Virus, Kaposi s sarcoma in the presence of any Human Immunodeficiency Virus, Any skin cancer other than malignant melanoma.

16 16 26 JUNE 1999 COMA CORONARY ARTERY BY-PASS SURGERY (CORONARY ARTERY BY-PASS GRAFTS) DEAFNESS HEART ATTACK HEART VALVE REPLACEMENT OR REPAIR HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) KIDNEY FAILURE LOSS OF LIMBS (LOSS OF HAND OR FOOT) A state of unconsciousness with no reaction to external stimuli or internal needs persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit. Coma secondary to alcohol or drug misuse is not covered. The undergoing of open heart surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding balloon angioplasty (except as defined in Angioplasty), laser relief or any other procedures. Total permanent and irreversible loss of all hearing in both ears. The death of a portion of the heart muscle as a result of inadequate blood supply as evidenced by an episode of typical chest pain, new electrocardiograph changes and by the elevation of cardiac enzymes. The evidence must be consistent with the diagnosis of heart attack. Undergoing open-heart surgery from medical necessity to replace or repair one or more heart valves. The permanent physical severance of two or more limbs from above the wrist or ankle joint. LOSS OF SPEECH Total, permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

17 17 26 JUNE 1999 MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE BEFORE AGE 65 (MOTOR NEURONE DISEASE) MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) The actual undergoing as a recipient of, or inclusion on an official UK waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow. Confirmation by a consultant neurologist of a definite diagnosis of motor neurone disease before the 65th birthday of the life assured. A definite diagnosis by a consultant neurologist of multiple sclerosis which satisfies all of the following criteria: There must be current impairment of motor or sensory function which must have persisted for a continuous period of at least six months. The diagnosis must be confirmed by diagnostic techniques current at the time of the claim. Total and irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. The disability must be permanent and supported by appropriate neurological evidence. PARKINSON S DISEASE BEFORE AGE 65 (PARKINSON S DISEASE) Confirmation by a consultant neurologist of a definite diagnosis of Parkinson s disease before the 65th birthday of the life assured. Parkinson s disease secondary to alcohol or drug misuse is not covered. PERMANENT AND TOTAL DISABILITY BEFORE AGE 65 (TOTAL AND PERMANENT DISABILITY) The Guaranteed Sum Assured will be payable: (a) If the Life Assured is not in any gainful occupation immediately before the onset of disability and suffers, through illness or accident, a mental or physical irreversible disability before the 65th birthday of the Life Assured which, in the opinion of the Chief Medical Officer of Legal & General, results in the Life Assured being permanently unable to perform, without the direct assistance of another person, four or more of the following functions: (i) mobility the ability to move from one room to another adjoining room or from one side of a room to another to get in and out of bed or a chair without requiring physical assistance of another person.

18 18 26 JUNE 1999 PERMANENT AND TOTAL DISABILITY BEFORE AGE 65 (TOTAL AND PERMANENT DISABILITY) Continued (ii) continence the ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene. (iii) dressing or undressing self putting on or taking off all necessary items of clothing without requiring assistance of another person. (iv) washing and bathing self washing or bathing to the extent needed to maintain personal cleanliness without requiring assistance of another person. (v) eating all tasks of getting food into the body once it has been prepared. (vi) toileting getting to and from the toilet, transferring on or off the toilet and associated personal hygiene. OR (b) One of the Any Occupation definition or Own Occupation definition wordings below. Any Occupation definition If the Life Assured is engaged in gainful occupation immediately before the onset of disability before the 65th birthday of the Life Assured and is, by reason of sickness or accident, totally unable to follow any occupation and in the opinion of the Chief Medical Officer of Legal & General is likely to remain so permanently. Such decision will be based on all of the medical evidence available. Own Occupation definition If the Life Assured is engaged in gainful occupation immediately before the onset of disability before the 65th birthday of the Life Assured and is, by reason of sickness or accident, totally unable to follow his/her occupation and in the opinion of the Chief Medical Officer of Legal & General is likely to remain so permanently. Such decision will be based on all of the medical evidence available. PRE SENILE DEMENTIA BEFORE AGE 65 (DEMENTIA) STROKE A diagnosis, before the 65th birthday of the Life Assured, by a consultant neurologist of presenile dementia. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas. THIRD DEGREE BURNS Third degree burns covering at least 20% of the body surface area.

19 19 20 OCTOBER 2002 Summary Changes to Cancer and Heart attack definitions. ALZHEIMER S DISEASE ANGIOPLASTY AORTA GRAFT SURGERY BENIGN BRAIN TUMOUR BLINDNESS CANCER (MOST MALIGNANT TYPES) (CANCER) COMA CORONARY ARTERY BY-PASS SURGERY (CORONARY ARTERY BY-PASS GRAFTS) Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin s disease but the following are excluded: All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ, All tumours of the prostrate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0, All forms of lymphoma in the presence of any Human Immunodeficiency Virus, Kaposi s sarcoma in the presence of any Human Immunodeficiency Virus, Any skin cancer other than invasive malignant melanoma. DEAFNESS

20 20 20 OCTOBER 2002 HEART ATTACK HEART VALVE REPLACEMENT OR REPAIR HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) KIDNEY FAILURE LOSS OF LIMBS (LOSS OF HAND OR FOOT) LOSS OF SPEECH The death of a portion of the heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: typical chest pain, new characteristic electrocardiograph changes, the characteristic rise of cardiac enzymes, troponins or other biochemical markers, where all of the above shows a definite acute myocardial infarction. Other acute coronary syndromes, including but not limited to angina, are not covered under this definition. MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS

21 21 20 OCTOBER 2002 PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) PARKINSON S DISEASE PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) PRESENILE DEMENTIA BEFORE AGE 65 (DEMENTIA) STROKE THIRD DEGREE BURNS

22 22 18 JANUARY 2004 Summary Changes to Alzheimer s Disease, Dementia, HIV infection through blood transfusion, HIV infection through assault, Kidney Failure, Motor Neurone Disease and Parkinson s Disease. Aplastic Anaemia, Bacterial Meningitis, Cardiomyopathy, Chronic Lung Disease, CJD, End Stage Liver Failure, Progressive Supranuclear Palsy added. Angioplasty removed. ALZHEIMER S DISEASE A diagnosis by a consultant neurologist of Alzheimer s disease. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas. AORTA GRAFT SURGERY APLASTIC ANAEMIA BACTERIAL MENINGITIS BENIGN BRAIN TUMOUR Permanent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following: blood transfusion marrow stimulating agents immunosuppresive agents bone marrow transplant. Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit. The diagnosis must be confirmed by a consultant neurologist. Bacterial meningitis in the presence of HIV infection is excluded. All other forms of meningitis including viral are not covered. BLINDNESS CANCER

23 23 18 JANUARY 2004 CARDIOMYOPATHY CHRONIC LUNG DISEASE (RESPIRATORY FAILURE) A definite diagnosis of cardiomyopathy made by a consultant cardiologist resulting in permanent impaired left ventricular function such that the ejection fraction is never greater than 40%. The diagnosis must also be evidenced by: electrocardiographic changes; echocardiographic abnormalities; both of which must be consistent with the diagnosis of cardiomyopathy. All other forms of heart disease, heart enlargement and myocarditis are specifically excluded. Cardiomyopathy related to alcohol or drug misuse is excluded. Confirmation by a consultant physician of end stage emphysema or other chronic lung disease, which requires regular oxygen treatment on a permanent basis. COMA CORONARY ARTERY BY-PASS SURGERY (CORONARY ARTERY BY-PASS GRAFTS) CREUTZFELDT-JAKOB DISEASE (CJD) DEAFNESS Diagnosis of Creutzfeldt-Jakob disease or New variant CJD made by a consultant neurologist, evidenced by a significant reduction in mental and social functioning so that permanent supervision or assistance by a third party is required. DEMENTIA A diagnosis by a consultant neurologist of dementia. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and the ability to reason and to perceive, understand, express and give effect to ideas.

24 24 18 JANUARY 2004 END STAGE LIVER FAILURE (LIVER FAILURE) HEART ATTACK End stage liver failure due to cirrhosis and resulting in all of the following: permanent jaundice ascites encephalopathy. Liver disease in the presence of HIV infection is excluded. Liver disease secondary to alcohol or drug misuse is excluded. HEART VALVE REPLACEMENT OR REPAIR HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) HIV/AIDS THROUGH BLOOD TRANSFUSION (HIV INFECTION) HIV/AIDS THROUGH ASSAULT (HIV INFECTION) Infection by HIV or AIDS provided: the infection results directly from a blood transfusion; the blood transfusion was given in the European Union (as at 1/11/2003), the Channel Islands or the Isle of Man after the cover start date; and there is clear evidence, satisfactory to us, that the infection was acquired from the blood transfusion. Infection by HIV or AIDS provided: the infection results directly from: (i) a physical assault involving involuntary contact with either a hypodermic needle or an infected sharp instrument; or (ii) a sexual assault; the incident happens in the European Union (as at 1/11/2003), the Channel Islands or the Isle of Man after the cover start date; the incident is reported to the police within five days; and a test, showing no HIV or HIV antibodies, is made within five days of the incident and a later test is made within 12 months showing infection by HIV or AIDS.

25 25 18 JANUARY 2004 KIDNEY FAILURE LOSS OF LIMBS (LOSS OF HAND OR FOOT) LOSS OF SPEECH MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) PARKINSON S DISEASE PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is initiated or renal transplant is initiated. Confirmation by a consultant neurologist of a definite diagnosis of motor neurone disease. Confirmation by a consultant neurologist of a definite diagnosis of Parkinson s disease. Parkinson s disease secondary to alcohol or drug misuse is not covered. PROGRESSIVE SUPRANUCLEAR PALSY The definite diagnosis of progressive supranuclear palsy by a consultant neurologist.

26 26 18 JANUARY 2004 STROKE THIRD DEGREE BURNS

27 27 25 JULY 2004 Summary PTD changed to TPD and ADLs replaced by FATs. ALZHEIMER S DISEASE AORTA GRAFT SURGERY APLASTIC ANAEMIA BACTERIAL MENINGITIS BENIGN BRAIN TUMOUR BLINDNESS CANCER CARDIOMYOPATHY CHRONIC LUNG DISEASE (RESPIRATORY FAILURE) COMA CORONARY ARTERY BY-PASS SURGERY (CORONARY ARTERY BY-PASS GRAFTS)

28 28 25 JULY 2004 CREUTZFELDT-JAKOB DISEASE (CJD) DEAFNESS DEMENTIA HEART ATTACK HEART VALVE REPLACEMENT OR REPAIR HIV/AIDS COVER FOR MEDICAL STAFF AND OTHER SPECIFIED GROUPS (HIV INFECTION) HIV/AIDS THROUGH BLOOD TRANSFUSION (HIV INFECTION) HIV/AIDS THROUGH ASSAULT (HIV INFECTION) KIDNEY FAILURE END STAGE LIVER FAILURE (LIVER FAILURE)

29 29 25 JULY 2004 LOSS OF LIMBS (LOSS OF HAND OR FOOT) LOSS OF SPEECH MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS PARALYSIS/PARAPLEGIA (PARALYSIS OF A LIMB) PARKINSON S DISEASE PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) The Guaranteed Sum Assured will be payable: (a) If the Life Assured is not in gainful occupation immediately before the onset of disability, and suffers through illness or accident, a mental or physical irreversible disability, which in the opinion of The Chief Medical Officer of Legal & General, results in the Life Assured being permanently unable to perform, without the direct assistance of another person, four or more of the following functions: (i) mobility the ability to move from one room to another adjoining room or from one side of a room to another to get in and out of a bed or a chair without requiring physical assistance of another person. (ii) continence the ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene. (iii) dressing or undressing self putting on and taking off of all necessary items of clothing without requiring assistance of another person. (iv) washing and bathing self washing or bathing to the extent needed to maintain personal cleanliness without requiring assistance of another person.

30 30 25 JULY 2004 PERMANENT AND TOTAL DISABILITY (TOTAL AND PERMANENT DISABILITY) Continued PROGRESSIVE SUPRANUCLEAR PALSY STROKE (v) eating all tasks of getting food into the body once it has been prepared. (vi) toileting getting to and from the toilet, transferring on or off the toilet and associated personal hygiene. OR (b) If the Life Assured is engaged in a gainful occupation immediately before the onset of disability and is, by reason of sickness or accident, totally unable follow his/her own/any occupation and in the opinion of Legal & General is likely to remain so permanently. Such decision will be based on all the medical evidence available. THIRD DEGREE BURNS

31 31 18 MARCH 2007 Summary ABI Statement of Best Practice 2006 changes new headings and wordings, Encephalitis, Primary Pulmonary Hypertension, Systemic Lupus Erythematosus, Terminal Illness and Traumatic Head Injury added. HIV infection definitions combined. Note: Chronic Lung Disease renamed Respiratory Failure. ALZHEIMER S DISEASE RESULTING IN PERMANENT SYMPTOMS AORTA GRAFT SURGERY REQUIRING SURGICAL REPLACEMENT A definite diagnosis of Alzheimer s disease by a consultant neurologist, psychiatrist or geriatrician. There must be permanent clinical loss of the ability to do all of the following: remember; reason; and perceive, understand, express and give effect to ideas. For the above definition, the following are not covered: Other types of dementia. The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches. For the above definition, the following are not covered: Any other surgical procedure, for example the insertion of stents or endovascular repair. APLASTIC ANAEMIA WITH PERMANENT BONE MARROW FAILURE BACTERIAL MENINGITIS RESULTING IN PERMANENT SYMPTOMS A definite diagnosis of aplastic anaemia by a consultant haematologist. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia. A definite diagnosis of bacterial meningitis resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered: All other forms of meningitis other than those caused by bacterial infection.

32 32 18 MARCH 2007 BENIGN BRAIN TUMOUR RESULTING IN PERMANENT SYMPTOMS BLINDNESS PERMANENT AND IRREVERSIBLE CANCER EXCLUDING LESS ADVANCED CASES CARDIOMYOPATHY OF SPECIFIED SEVERITY A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered: Tumours in the pituitary gland Angiomas. Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in the better eye using a Snellen eye chart. Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, lymphoma and sarcoma. For the above definition, the following are not covered: All cancers which are histologically classified as any of the following: pre-malignant; non-invasive; cancer in situ; having either borderline malignancy; or having low malignant potential. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0. Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A. Any skin cancer other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin). A definite diagnosis of cardiomyopathy by a consultant cardiologist. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classifications of functional capacity*. For the above definition, the following are not covered: Cardiomyopathy secondary to alcohol or drug abuse. All other forms of heart disease, heart enlargement and myocarditis. * NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

33 33 18 MARCH 2007 COMA RESULTING IN PERMANENT SYMPTOMS A state of unconsciousness which: requires the use of life support systems; and results in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Coma secondary to alcohol or drug abuse. CORONARY ARTERY BY-PASS GRAFTS WITH SURGERY TO DIVIDE THE BREASTBONE CREUTZFELDT-JAKOB DISEASE (CJD) RESULTING IN PERMANENT SYMPTOMS DEAFNESS PERMANENT AND IRREVERSIBLE DEMENTIA RESULTING IN PERMANENT SYMPTOMS The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. A definite diagnosis of Creutzfeldt-Jakob disease made by a consultant neurologist. There must be permanent clinical loss of the ability in mental and social functioning to the extent that permanent supervision or assistance by a third party is required. Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram. A definite diagnosis of dementia by a consultant neurologist, psychiatrist or geriatrician. The diagnosis must be supported by evidence of progressive loss of ability to do all of the following: remember; to reason; and to perceive, understand, express and give effect to ideas. For the above definition, the following are not covered: Dementia secondary to alcohol or drug abuse.

34 34 18 MARCH 2007 ENCEPHALITIS RESULTING IN PERMANENT SYMPTOMS HEART ATTACK OF SPECIFIED SEVERITY HEART VALVE REPLACEMENT OR REPAIR WITH SURGERY TO DIVIDE THE BREASTBONE HIV INFECTION CAUGHT FROM A BLOOD TRANSFUSION, PHYSICAL ASSAULT OR ACCIDENT AT WORK A definite diagnosis of encephalitis by a consultant neurologist resulting in permanent neurological deficit with persisting clinical symptoms. Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: New characteristic electrocardiographic changes. The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher; Troponin T > 1.0 ng/ml AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods. The evidence must show a definite acute myocardial infarction. For the above definition, the following are not covered: Other acute coronary syndromes including but not limited to angina. The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to replace or repair one or more heart valves. Infection by Human Immunodeficiency Virus resulting from: a blood transfusion given as part of medical treatment in the European Union, the Channel Islands or the Isle of Man; a physical assault; or an incident occurring during the course of performing normal duties of employment; after the start of the policy and satisfying all of the following: The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures.

35 35 18 MARCH 2007 HIV INFECTION CAUGHT FROM A BLOOD TRANSFUSION, PHYSICAL ASSAULT OR ACCIDENT AT WORK Continued KIDNEY FAILURE REQUIRING DIALYSIS Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within five days of the incident. There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus. For the above definition, the following is not covered: HIV infection resulting from any other means, including sexual activity or drug abuse. Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary. LIVER FAILURE OF ADVANCED STAGE Liver failure due to cirrhosis and resulting in all of the following: permanent jaundice ascites encephalopathy. For the above definition, the following are not covered: Liver disease secondary to alcohol or drug abuse. LOSS OF HANDS OR FEET PERMANENT PHYSICAL SEVERANCE (LOSS OF HAND OR FOOT) Permanent physical severance of any combination of two or more hands or feet at or above the wrist or ankle joints. LOSS OF SPEECH PERMANENT AND IRREVERSIBLE Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

36 36 18 MARCH 2007 MAJOR ORGAN TRANSPLANT MOTOR NEURONE DISEASE RESULTING IN PERMANENT SYMPTOMS The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver, lung, or pancreas, or inclusion on an official UK waiting list for such a procedure. For the above definition, the following is not covered: Transplant of any other organs, parts of organs, tissues or cells. A definite diagnosis of motor neurone disease by a consultant neurologist. There must be permanent clinical impairment of motor function. MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS PARALYSIS OF LIMBS TOTAL AND IRREVERSIBLE (PARALYSIS OF A LIMB) PARKINSON S DISEASE RESULTING IN PERMANENT SYMPTOMS PRIMARY PULMONARY HYPERTENSION OF SPECIFIED SEVERITY A definite diagnosis of multiple sclerosis by a consultant neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least six months. Total and irreversible loss of muscle function to the whole of any two limbs. A definite diagnosis of Parkinson s disease by a consultant neurologist. There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability. For the above definition, the following is not covered: Parkinson s disease secondary to drug abuse. A definite diagnosis of primary pulmonary hypertension. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classifications of functional capacity*. * NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain. For the above definition, the following are not covered: Pulmonary hypertension secondary to any other known cause i.e. not Primary.

37 37 18 MARCH 2007 PROGRESSIVE SUPRANUCLEAR PALSY RESULTING IN PERMANENT SYMPTOMS RESPIRATORY FAILURE OF ADVANCED STAGE STROKE RESULTING IN PERMANENT SYMPTOMS SYSTEMIC LUPUS ERYTHEMATOSUS WITH SEVERE COMPLICATIONS TERMINAL ILLNESS A definite diagnosis of progressive supranuclear palsy by a consultant neurologist. There must be permanent clinical impairment of eye movements and motor function. Advanced stage emphysema or other chronic lung disease, resulting in all of the following: The need for regular oxygen treatment on a permanent basis. The permanent impairment of lung function tests as follows; Forced Vital Capacity (FVC) and Forced Expiratory Volume at 1 second (FEV1) being less than 50% of normal. Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered: Transient ischaemic attack. Traumatic injury to brain tissue or blood vessels. A definite diagnosis of systemic lupus erythematosus by a consultant rheumatologist resulting in either of the following: Permanent neurological deficit with persisting clinical symptoms; or The permanent impairment of kidney function tests as follows; Glomerular Filtration Rate (GFR) below 30 ml/min. Advanced or rapidly progressing incurable illness where, in the opinions of an attending consultant and our Chief Medical Officer, the life expectancy is no greater than 12 months for the above definition, the following is not covered: Terminal Illness as defined above during the last eighteen months of the policy. THIRD DEGREE BURNS COVERING 20% OF THE BODY S SURFACE AREA Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body s surface area.

38 38 18 MARCH 2007 TOTAL AND PERMANENT DISABILITY TRAUMATIC HEAD INJURY RESULTING IN PERMANENT SYMPTOMS The Guaranteed Sum Assured will be payable: (a) If the Life Assured is not in gainful occupation immediately before the onset of disability, and suffers through illness or accident, a mental or physical irreversible disability, which in the opinion of The Chief Medical Officer of Legal & General, results in the Life Assured being permanently unable to perform, without the direct assistance of another person, three or more of the following functions: 1. Walking: The ability to walk a distance of 200 metres on flat ground with or without the aid of a walking stick and without stopping or experiencing discomfort. 2. Bending: The ability to get into or out of a standard saloon car, and the ability to bend or kneel to pick up an object from the floor and straighten up again. 3. Communicating: The ability to answer a telephone and to take a message. 4. Reading: Having the required eyesight (corrected if necessary) to be able to read a daily newspaper. OR 5. Writing: Having the physical ability to write legibly using a pen or a pencil without aid. 6. Climbing: Having the ability to climb up a flight of 12 stairs without stopping or suffering severe discomfort. (b) If the Life Assured is engaged in a gainful occupation immediately before the onset of disability and is, by reason of sickness or accident, totally unable to follow his/her own occupation and in the opinion of Legal & General is likely to remain so permanently. Such decision will be based on all the medical evidence available. If in gainful employment the claim will be assessed on the occupation followed immediately before the onset of disability. Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms.

39 39 23 Summary Changes to Benign Brain Tumour, Coma, Coronary Artery By-pass Grafts, Heart Valve Replacement or Repair, HIV infection, Loss of hand or foot, Paralysis of a limb, Parkinson s Disease and Third Degree Burns. Mastectomy, Multiple System Atrophy, Open Heart Surgery and Removal of an Eyeball added. ALZHEIMER S DISEASE AORTA GRAFT SURGERY APLASTIC ANAEMIA BACTERIAL MENINGITIS BENIGN BRAIN TUMOUR RESULTING IN EITHER SURGICAL REMOVAL OR PERMANENT SYMPTOMS BLINDNESS CANCER CARDIOMYOPATHY COMA RESULTING IN PERMANENT SYMPTOMS A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in either surgical removal or permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered: Tumours in the pituitary gland. Angiomas. A state of unconsciousness with no reaction to external stimuli or internal needs which results in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Coma secondary to alcohol or drug abuse.

40 40 23 CORONARY ARTERY BY-PASS GRAFTS WITH SURGICAL THORACOTOMY CREUTZFELDT-JAKOB DISEASE (CJD) DEAFNESS DEMENTIA ENCEPHALITIS HEART ATTACK HEART VALVE REPLACEMENT OR REPAIR WITH SURGICAL THORACOTOMY HIV INFECTION CAUGHT FROM A BLOOD TRANSFUSION, PHYSICAL ASSAULT OR ACCIDENT AT WORK The undergoing of surgery requiring anterolateral thoracotomy on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. For the above definition the following are not covered: balloon angioplasty atherectomy rotablation insertyion of stents, and laser treatment. The undergoing of surgery requiring anterolateral thoracotomy on the advice of a consultant cardiologist to replace or repair one or more heart valves. Infection by Human Immunodeficiency Virus resulting from: a blood transfusion given as part of medical treatment a physical assault; or an incident occurring during the course of performing normal duties of employment; after the start of the policy and satisfying all of the following:

41 41 23 HIV INFECTION CAUGHT FROM A BLOOD TRANSFUSION, PHYSICAL ASSAULT OR ACCIDENT AT WORK Continued The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures. Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within five days of the incident. There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus. The incident causing infection must have occurred in one of the following countries: Australia, Austria, Belgium, Bulgaria, Canada, the Channel Islands, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, the Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Norway, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the United States of America. For the above definition, the following is not covered: HIV infection resulting from any other means, including sexual activity or drug abuse. KIDNEY FAILURE LIVER FAILURE LOSS OF HAND OR FOOT PERMANENT PHYSICAL SEVERANCE LOSS OF SPEECH Permanent physical severance of a hand or foot at or above the wrist or ankle joints. MAJOR ORGAN TRANSPLANT

42 42 23 MASTECTOMY FOR DUCTAL CARCINOMA IN SITU (DUCTAL CARCINOMA IN SITU OF THE BREAST) REQUIRING TOTAL REMOVAL OF THE BREAST MOTOR NEURONE DISEASE MULTIPLE SCLEROSIS The undergoing of a mastectomy operation (total removal of all the tissue of at least one breast) on the advice of your hospital consultant following the diagnosis of ductal carcinoma in situ of the breast. For the above definition, the following are not covered: Prophylactic mastectomy without histological evidence of ductal carcinoma in situ, and Any other surgical procedures such as lumpectomy, partial mastectomy and partial or total sub cutaneous mastectomy. MULTIPLE SYSTEM ATROPHY RESULTING IN PERMANENT SYMPTOMS A definite diagnosis of multiple system atrophy by a consultant neurologist. There must be evidence of permanent clinical impairment of either: motor function with associated rigidity of movement or the ability to coordinate muscle movement or bladder control and postural hypotension. OPEN HEART SURGERY WITH MEDIAN STERNOTOMY The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to correct any structural abnormality of the heart. PARALYSIS OF A LIMB TOTAL AND IRREVERSIBLE Total and irreversible loss of muscle function to the whole of any one limb. PARKINSON S DISEASE RESULTING IN PERMANENT SYMPTOMS A definite diagnosis of Parkinson s disease by a consultant neurologist. There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability.